New recommendations from the US Preventive Services Task Force suggest that adolescents be routinely screened for depression by primary care doctors, including family physicians and pediatricians.
These doctors should be prepared to refer young people to treatment for depression if necessary, writes Carina Storrs for CNN. The recommendations were announced in the Annals of Internal Medicine.
The Task Force decided there was valid evidence to support such screening for all kids 12 to 18. For children who are younger than 12, more evidence will be needed to find tests that are useful and treatments that are effective before a recommendation that doctors screen all young people in this age group can be proposed.
Dr. Alex H. Krist, a family medicine associate professor at Virginia Commonwealth University and a member of the Task Force, said the advice is similar to recommendations for adults (18 and older).
The last version of the recommendations, which came in 2009, stated that adults and adolescents should only be screened for depression if “systems were in place to help at-risk individuals get appropriate treatment and follow-up care.” The new iteration adds that doctors should have those systems in place and should screen everyone.
The types of systems that primary care physicians should have in place were not outlined by the Task Force, but examples would be having mental health providers within the primary care practice or ensuring that patients are referred to therapists at other practices or in the community.
Another addition to the current guidelines is that physicians are asked to support the use of medication for treating depression in adolescents.
“In 2009 the evidence of benefits was around therapy … so we were advocating therapy. Now we are saying it can be medication, therapy or a combination,” Krist said.
For this age group, cognitive behavioral therapy, which includes modifying thoughts and behavior, is commonly prescribed. Escitalopram, or Lexapro, was linked to better recovery from the symptoms of depression for adolescents 12 to 17 than a placebo and was not connected to increased adverse effects.
Fluoxetine, or Prozac, and Lexapro are the two antidepressants approved for adolescents starting at ages 8 and 12, respectively. Recommendations for medication and therapies were made based on whether they reduced the rate of suicides, improved the quality of lives, and the enhanced physical and social health of young people.
Krist added that 17% of US high school students have seriously considered taking their lives within the last year, and 8% have attempted to do so.
Essentially, all individuals in the US who are older than 12 will be examined periodically for signs of irritability, sadness, loss of appetite or energy, changes in sleep patterns, or feelings of worthlessness or guilt. When a patient presents symptoms of depression, doctors are to be ready to recommend treatment.
The Los Angeles Times’ Melissa Healy writes that older children who are diagnosed with depression have a more complicated treatment than most adults. For patients under 24, the FDA recommends close monitoring of anyone taking a selective serotonin re-uptake inhibitor (SSRI) antidepressant because a side effect of the drug is an increased risk of suicidal thoughts and suicide.
Teenagers were much more likely to improve if they received psychotherapy and medication together. And even though major depressive disorder is thought to affect 8% of adolescents annually, only between 36% and 44% of those report they have received treatment.
Normally symptoms appear around 14 to 15 years of age, with girls being over twice as likely to show symptoms as boys. When depression hits at an early age, it is common for an individual to have the symptoms recur later in life.
Columbia University psychiatrist Dr. Mark Olfson applauds the new recommendations because wellness visits “provide an ideal opportunity to screen adolescents for depression.”
“The new recommendations have the potential to spur improved detection and appropriate triage of depressed adolescents,” Olfson said.